Exclusion Screenings

Step One: Each individual you employ as well as each associate of the entities you contract to perform administrative health services on behalf of IlliniCare Healthare screened against the OIG (LEIE) and GSA exclusion lists prior to hire and monthly thereafter.

"Confirm Vendor Address" must be completed properly before submitting.

City *

"Confirm City" must be completed properly before submitting.

State *

Error:
This field is required.

ZIP Code *

"Confirm ZIP Code" must be completed properly before submitting.

Vendor Phone *

"Confirm Vendor Phone" must be completed properly before submitting.

Vendor Email *

"Confirm Vendor Email" must be completed properly before submitting.

Exclusion Screening Attestation *

I certify, as the authorized representative having responsibility directly or indirectly for all employees, contracted personnel, providers/practicioners, and vendors who provide health care or administrative services under Medicaid and/or Medicare, that the statements below are true and correct to the best of my knowledge.At least one checkbox from "Exclusion Screening Attestation" must be checked before submitting.